Association Between Neighborhood Socioeconomic Status and 30-Day Mortality and Readmission for Patients With Common Neurologic Conditions

Abstract

Background and Objectives:

Patients of low individual socioeconomic status are at greater risk for unfavorable health outcomes. However, the association between neighborhood socioeconomic deprivation and health outcomes for patients with neurological disorders has not been studied at the population level. Our objective was to determine the association between neighborhood socioeconomic deprivation and 30-day mortality and readmission after hospitalization for various neurological conditions.

Methods:

This was a retrospective study of nationwide Medicare claims from 2017-2019. We included patients over the age of 65 years hospitalized for the following broad categories based on diagnosis related groups (DRG): Multiple Sclerosis and Cerebellar Ataxia [DRG 058-060]; Stroke, [061-072]; Degenerative Nervous System disorders [056-057]; Epilepsy [100-101]; Traumatic Coma [082-087], and Non-Traumatic Coma [080-081]. The exposure of interest was neighborhood socioeconomic status, measured by the Area Deprivation Index (ADI) which uses socioeconomic indicators, such as educational attainment, unemployment, infrastructure access, income, etc. to estimate area-level socioeconomic deprivation at the level of census block groups. Patients were grouped into high, middle, and low neighborhood-level SES based on ADI percentiles. Adjustment covariates included age, comorbidity burden, race/ethnicity, individual socioeconomic status, and sex.

Results:

After exclusions, 905,784 patients were included in the mortality analysis and 915,993 were included in the readmission analysis. After adjustment for age, sex, race/ethnicity, comorbidity burden, and individual socioeconomic status, patients from low SES neighborhoods had higher 30-day mortality rates compared to patients from high SES neighborhoods for all disease categories except for multiple sclerosis: magnitudes of the effect ranged from an adjusted odds ratio (aOR) of 2.46 (95% Confidence Interval [CI] 1.60-3.78) for the non-traumatic coma group to 1.23 (95% CI 1.19-1.28) for the stroke group. After adjustment, no significant differences in readmission rates were observed for any of the groups.

Discussion:

Neighborhood socioeconomic status is strongly associated with 30-day mortality for many common neurological conditions even after accounting for baseline comorbidity burden and individual socioeconomic status. Strategies to improve health equity should explicitly consider the effect of neighborhood environments on health outcomes.